'The best friend Medicare ever had'?: Policy narratives and changes in Coalition health policy
As Leader of the Opposition in 1987, the current Prime Minister of Australia John Howard, stated unequivocally that he would dismantle Medicare at his first opportunity.
By April 2000, the Health Minister in a Howard-led government proudly proclaimed to the Australian Parliament the Coalition was 'the best friend Medicare ever had'. Such a shift in ideology and policy position appears remarkable, overturning more than 60 years of conservative opposition to a universal, publicly funded, health care system.
This paper traces the shift from the lead-up to the 1996 election until 2000, interrogating official policy texts to map how the Coalition reconfigured its own policy narrative about the Australian health care system. This paper argues that in order to understand contemporary reforms to the health care system, we must consider the way in which those reforms provide solutions to discursively, rather than objectively constructed, policy problems.
University of Sydney, NSW
Bacchi C (1999) Women, Policy and Politics: the Construction of Policy Problems. Sage Publications: London.
Badham J and Bandrup J (2000) Length of stay comparisons for private and public hospitals. Australian Health Review 23(3):162-170.
Battin T (1998) Unmaking the Australian Keynesian way. in Smyth P and Cass B (eds) Contesting the Australian Way: States, Markets and Civil Society. Cambridge University Press: Cambridge.
Bessant J (2002a) Dawkins' higher education reforms and how metaphors work in policy making. Journal of Higher Education Reform and Management 24(1):87-99.
Bessant J (2002b) The politics of official talk about welfare reform in Australia. Just Policy 28:12-22.
Bishop J (1999) House of Representatives, Debates Wednesday 9 June, Commonwealth of Australia: Canberra: 6424-6425.
Butler J (2002) Policy change and private health insurance: did the cheapest policy do the trick? Australian Health Review 26(6):33-41.
Cass B (1999) Who's afraid of the welfare state? Contemporary debates about the state of flexible work/flexible welfare. Arts: The Journal of the Sydney University Arts Association 21:9-36.
Cass B and Brennan D (2002) Communities of support or communities of surveillance and enforcement in welfare reform debates. Australian Journal of Social Issues 37(3):261-262.
Cass B (1998) The social policy context. In Smyth P and Cass B (eds) Contesting the Australian Way: States, Markets and Civil Society. Cambridge University Press: Cambridge.
Cass B and Brennan D (2003) Taxing Women: the politics of gender in the tax/transfer system. eJournal of Tax Research 1(1):37-63.
Crichton A (1990) Slowly Taking Control? Australian Governments And Health Care Provision 1788-1988. Allen and Unwin: Sydney.
De-Anne K (2000) House of Representatives, Debates Tuesday 11 April, Commonwealth of Australia: Canberra:15690.
Dodson L (1987) Howard plans radical changes to Medicare. The Australian Financial Review 2 June:1-2.
Duckett S (2005) Private care and public waiting. Australian Health Review 29(1):87-93.
Duckett S and Jackson T (2000) The new health insurance rebate: an inefficient way of assisting public hospitals. Medical Journal of Australia 172:439-442.
Elliot A (2002) The Decline in Bulk Billing: Explanations and Implications. Parliamentary Library: Canberra.
Elliot A (2003) Is Medicare Universal? Parliamentary Library: Canberra.
Elliot A and Hancock N (2003) Health Legislation Amendment (Medicare and Private Health Insurance) Bill 2003 Parliamentary Library: Canberra.
Elliot A (2005) The Mirror of Erised: Health care reform and John Howard's heart's desire. The Australian Sociological Association Annual Conference refereed proceedings: Hobart.
Gardner H (ed) (1997) Health Policy in Australia. Oxford University Press: Melbourne.
Georgio P (2000) House of Representatives, Debates Tuesday 11 April, Commonwealth of Australia: Canberra:15684.
Gillespie J (1991) The Price of Health: Australian Governments And Medical Politics. Cambridge University Press: Cambridge.
Gray G (1991) Federalism and Health Policy: The Development Of Health Systems in Canada and Australia. University of Toronto Press: Toronto.
Gray G (2000a) ‘Private practice publicly supported’: Equity in hospital and medical financing. Just Policy 18:4-14.
Gray G (2000b) Maintaining Medicare: rhetoric or reality? New Doctor 72:5-7.
Gray G (2004) The Politics Of Medicare: Who Gets What, When And How. UNSW Press: Sydney.
Hall J (2001) The public view of private health insurance, Centre for Health Economics, Research and Evaluation, University of Sydney: Camperdown.
Hall J, De Abreu Lourenco R and Viney R (1999) Carrots and sticks - the fall and fall of private health insurance. Health Economics 8(8):653-660.
Howard J (1987a) Doorstop Interview 1 June Transcript, Parliament House: Canberra.
Howard J (1987b) Address 5 November to the Opening of the Australian Private Hospitals Association 7th National Congress: Canberra.
Howard J (1996a) The Great Debate 1, 11 February [with Ray Martin and Paul Keating]: transcript available at http://parlinfoweb.aph.gov.au/piweb/view_document.aspx?id=18493&table=PRESSREL last accessed 12 December 2004.
Howard J (1996b) A Healthy Future, Launch of the Coalitions Health Policy Transcript of the Leader of the Opposition 12 February, Press Conference: Brisbane: available at http://parlinfoweb.aph.gov.au/piweb/repository1/media/pressrel/JNQ201.pdf last accessed 12 December 2004.
Howard J (2000a) House of Representatives Debates Tuesday 11 April, Commonwealth of Australia: Canberra:15659.
Howard J (2000b) House of Representatives, Debates Monday 14 August, Commonwealth of Australia: Canberra:18838.
Industry Commission (1997) Private Health Insurance Industry Industry Commission Inquiry Report No 57, AGPS: Canberra.
Patmore G (2002) Changes in the nature of work and employment relations an historical perspective. In Callus R and Lansbury R (eds) Working Futures: The Changing Nature of Work and Employment Relations in Australia. The Federation Press: Sydney.
Peat B, Roberts C and Tracy S (2000) Rates for obstetric intervention among private and public patients in Australia: population based descriptive study. British Medical Journal 321(7254):137-141.
Sax S (1984) A Strife of Interests: Politics And Policies in Australian Health Services. George Allen and Unwin: Sydney.
Sax S (1990) Health Care Choices and the Public Purse. Allen and Unwin: Sydney.
Shorten A and Shorten B (1999) Episiotomy in NSW hospitals 1993-1996: towards understanding variations between public and private hospitals. Australian Health Review 22(1):18-25.
Smyth P (1998) The rise and fall of full employment? In Cass B and Couch R (eds) Divided Work Divided Society: Employment, Unemployment and Income Distribution in 1990's in Australia. The University of Sydney: Sydney.
Swerissen H and Duckett S (1997) Health policy and financing. In Gardner H (ed) Health Policy in Australia. Oxford University Press: Melbourne.
Wooldridge M (1996a) House of Representatives, Debates Friday 13 December, Commonwealth of Australia: Canberra:8005.
Wooldridge M (1997a) Media Release: Advertising Puts Private Health In The Fast Lane 1 July: available at http://health.gov.au/internet/wcms/publishing.nsf/Content/
health-archive-mediarel-1997-mw6697.htm last accessed 1 December 2004.
Wooldridge M (1997b) Media Release: Government To Maintain Community Rating As Keystone Of Strengthened Private Health Insurance System 10 April: available at http://www.health.gov.au/internet/wcms/publishing.nsf/Content/
health-archive-mediarel-1997-mw2797.htm last accessed 11 April 2004.
Wooldridge M (1999a) House of Representatives, Debates Wednesday 2 June, Commonwealth of Australia: Canberra:5753.
Wooldridge M (1999b) House of Representatives, Debates Wednesday 2 June, Commonwealth of Australia: Canberra:5821.
Wooldridge M (2000a) Media Release: National Survey Reveals Massive Support For Lifetime Health Cover 21 March: available at http://www.health.gov.au/internet/wcms/publishing.nsf/Content/
health-mediarel-yr2000-mw-mw20025.htm last accessed 2 December 2004.
Wooldridge M (2000b) House of Representatives, Debates Tuesday 11 April, Commonwealth of Australia: Canberra:15661.
Yeatman A (1998) Activism and the policy process. In Yeatman A (ed) Activism and the Policy Process. Allen and Unwin: Sydney.
health policy, Medicare, private health insurance, social policy, sociology
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